Interviews

In the smaller northern Idaho community of Coeurd’Alene exist many different physicians dealing with the problems of access to care for their under and uninsured patients. Coeurd’Alene Pedaitrics is a large practice within the Coeurd’Alene area, serving thousands of children from infants up to young adults in college. They have been in existence for over twenty years, serving their patients to the best of their ability.
Dr. Mary Jo Shaw MD, has been a practicing pediatrician at CDA Pediatrics for the majority of its existence. Through e-mail correspondence, she reflected on the services her practice provides and her experience with this underserved population.

Does your practice provide healthcare to the under and uninsured population? (ie Medicaid)
We provide care for medicaid patients. To my knowledge, we are the
only practice that takes new patients with Medicaid. (except newborns)

Do you feel this is somewhat of a financial burden to your practice?
Since Medicaid does not pay as well as private insurance for the
same service, it is definitely a financial burden. However, we have
a very efficient practice (we work our employees hard!) so we are
able to see a large portion of Medicaid patients(over 50% of our
patients are Medicaid). Also, Idaho reimburses better than a lot of
states. Family doctors do not get reimbursed as well for adult
medicaid patients, so they are hesitant to take children who have
parents on Medicaid. Dental reimbursement is very bad!! The pediatric
dentists have all restricted the number of medicaid patients they
will se due to the poor reimbursement. So even though the Medicaid
program states they provide dental care, the parents cannot find a
dentist to see their children!!

Do you have any specific reasoning behind why you provide this care?
Since so many children in our area have Medicaid, we feel
compelled to provide care for them as part of our goal to provide
pediatric care to the community.

Could you briefly explain why you feel others within your profession choose not to provide this care?
Since Medicaid does not reimburse as well as private insurance
companies, many practices will not participate. Some providers also
seem to have a bias against Medicaid recipients. Medicaid requires a
lot of paper work for referrals and certain meds-even ones they
cover, you have to complete a "prior authorization form" for several
meds. The form has to be faxed to the state office and then they
review it and fax back a response to you and the pharmacy.

Do you follow a certain protocol when dealing with patients who have no insurance?
If a patient does not have insurance, they are required to pay 1/2
of the cost of the first visit as a new patient (as are all new
patients). For future visits, they are told we request payment at the
time of the visit but we will bill them. As long as they pay toward
their balance on a regular basis, we will continue to see them.

Mary Ann Daley is part of the office managing team for Coeurd’Alene Pediatrics. She works with patients over the phone and in person concerning any scheduling, billing, and insurance problems. As an involved team member without a degree in medicine, she has a different relationship with the patients of her office. The following are her responses to the same questions over e-mail.

Does your practice provide healthcare to the under and uninsured population? (ie Medicaid)
Yes

Do you feel this is somewhat of a financial burden to your practice?
Yes. The front staff has to check each medicaid patient's
eligibility at each visit since this changes from month to month.
Medicaid does not reimburse as well as other insurance plans but you
still hve the same overhead. Medical offices have a huge overhead to
cover.

Do you have any specific reasoning behind why you provide this care?
The doctors decide which insurance types they will contract with.

Could you briefly explain why you feel others within your profession choose not to provide this care?
Reimbursement and billing issues. Medicaid does not cover certain
procedures such as circumcision. The billing staff has to monitor
what codes are not paid well. Medicaid requires a referral for a
patient to be seen at any office other than ours (specialist or
urgent care). There are a lot of phone calls and paper work involved
with these referrals.

Do you follow a certain protocol when dealing with patients who have no insurance?
Same as above. We do have a program called Wee Care that provides
well child checks for children during their first year for free. We
do require patients to show us that they have been denied by Medicaid
to qualify for this program. Some parents don't want to apply for
Medicaid since the mom has to list the father's name. We also
participate in a voucher program through the Health dept. If a
patient presents to the health dept for an illness and they cannot
afford a doctor's visit, the health nurse can provide the family with
a voucher to be seen for free in our office for one visit. This does
not help with chronic conditions. The Dirne clinic is also a resource
for patients with no insurance. We provide immunizations through our
office at no cost if parents cannot pay. (we are part of the state
immunization program so get the immunizations from the state but
still have the overhead of the office staff and supplies).

Dr. Robin Shaw MD has been an Emergency Physician for the past 20 years at Kootenai Medical Center in Coeurd’Alene, Idaho. As a member of the Emergency Department, he is required to see all patients who come to the hospital seeking out care. He was also requested to answer the same questions over e-mail. Although he is involved with a branch of medicine that is required by law to see all patients, he still can contribute to this discussion of lack of care.

Does your practice provide healthcare to the under and uninsured population? (ie Medicaid)
yes

Do you feel this is somewhat of a financial burden to your practice?
yes. However, we have an arrangement with the hospital where we
are contracted to get paid a certain percentage of our charges, so
the hospital helps share the burden.

Do you have any specific reasoning behind why you provide this care?
Required by law.

Could you briefly explain why you feel others within your profession choose not to provide this care?
Poor reimbursement.

Do you follow a certain protocol when dealing with patients who have no insurance?
All patients are treated equally. They are billed later so don't
pay at the time of service. The billing department for the hospital
handles delinquent payments.

This information is contained on a video